AMA committee endorses Ryan-esque Medicare reform

posted at 10:41 am on October 16, 2012 by Ed Morrissey

The exchange on Medicare may have been the most substantive and interesting part of the Vice President debate last Thursday night. Paul Ryan explained that the Obama administration’s robbing of Medicare Advantage to pay for Medicaid expansion would accelerate the bankruptcy of Medicare, while Joe Biden in one of his calmer moments attacked Ryan for proposing a “voucher” program. Biden claimed to have the support of the AMA in opposing free-market-based reforms such as Ryan’s proposal uses, and dramatically asked, “Who [will] you believe, the AMA, me?”

Like so much of what Biden had to say — when he was actually saying something, rather than just grinning, laughing, and grunting into his microphone — this turns out to be false. Avik Roy at Forbes reports that a key committee of the American Medical Association just endorsed the use of “defined contribution” plans as a reform path for Medicare — the very same mechanism contained in Paul Ryan’s plan, the one derided by Biden as a “voucher” plan:

I’ve had my disagreements with the AMA, which like its cousin the AARP, generates hundreds of millions of dollars in income from our existing, wasteful health-care system, and often stands in the way of needed reforms. But this past weekend, the AMA’s key policy committee, the Council on Medical Service, voted to endorse a Medicare reform planthat shares key traits with the ones put forth by Mitt Romney and Paul Ryan.

“The [AMA] policy identifies changes that must be made to strengthen the traditional Medicare program (i.e., restructuring beneficiary cost-sharing, including modifying Medigap rules, and changing the eligibility age to match Social Security),” the Council writes, “and expresses support for giving beneficiaries a choice of plans for which the federal government would contribute a standard amount (i.e., a ‘defined contribution’) toward the purchase of traditional fee-for-service Medicare or another health insurance plan approved by Medicare. The Council firmly believes that implementing a defined contribution system, with strong regulatory protections for patients, is a responsible and feasible approach to strengthening the Medicare program.”

Much like the old Ryan plan, the AMA proposal would let the government provide a specified subsidy—the “defined contribution”—to retirees’ health benefits, and let them choose among a range of plans. Unlike the old Ryan plan, but like the current Romney-Ryan one, the AMA committee endorsed preserving “traditional Medicare as an option” for seniors.

Wow — I just bet that Mitt Romney used his vampire-capitalist money to pervert the AMA’s Council on Medical Service. He sent Grover Norquist in there with his toxic Taxpayer Pledge, didn’t he? Er … not exactly:

The AMA Council’s report states that it came around to this view not at the behest of Republican operatives or candidates, but after speaking with Bill Clinton’s former budget chief, Alice Rivlin, who along with Paul Ryan proposed a version of this plan. “Dr. Rivlin emphasized that defined contribution amounts should be sufficient to ensure that all beneficiaries could afford to purchase health insurance coverage, and that private health insurance plans should be subject to regulations that protect patients and ensure the availability of coverage for even the sickest patients.”

D’oh!

The AMA Council has somewhat different ideas on how to implement this kind of plan than Ryan does. They want less control on premium costs, for one thing, which would eventually force doctors to get paid less for their services, as Roy notes in his thoughtful analysis. But the core of their plan has the same mechanism as Ryan’s does — the federal exchange system that allows private-sector insurers to compete for Medicare customers, while keeping traditional Medicare as an option for those consumers who want it. In fact, that’s exactly the same mechanism that ObamaCare uses at the state level, a point that seems to have escaped Biden’s notice during all of his grunting and grinning on Thursday night.

Breaking on Hot Air

Blowback

Note from Hot Air management: This section is for comments from Hot Air's community of registered readers. Please don't assume that Hot Air management agrees with or otherwise endorses any particular comment just because we let it stand. A reminder: Anyone who fails to comply with our terms of use may lose their posting privilege.

On topic: Isn’t it strange how the left completely miss characterizes the “voucher” as not being enough to cover health care costs? It’s as though they think the plan is to cover all costs out of pocket rather than to purchase insurance.

On topic: Isn’t it strange how the left completely miss characterizes the “voucher” as not being enough to cover health care costs? It’s as though they think the plan is to cover all costs out of pocket rather than to purchase insurance.

BKeyser on October 16, 2012 at 10:47 AM

It’s a dishonest argument. They act as if Medicare will pay infinite dollars to keep grandma alive. No rationing ever occurs, and Medicare happily pays for anything you want. How about a system where you get to choose what is covered and what isn’t and send your dollars there?

Also, this is slightly OT, but those electric scooter commercials on TV piss me off, not because I want to keep old people from having electric scooters when they need them, but because the announcer says, “get yours today, and it is FREE!” Well, it is not free, maybe it is because of things like this, multiplied out 1000 times that the system is going bankrupt.

It will not save our nation. The amount of money “defined contribution” will just be another place where politicians buy votes. Vote for me, and I will increase your “defined contribution” amount so you can either pay less for your gold plated insurance plan, or you can upgrade from bronze to silver and still pay nothing. Vote for me and I will make sure the minimum plan includes your desired medical care choices, such as Viagra prescriptions paid for and your vaginal revirgination treatments!

It will not save our nation. The amount of money “defined contribution” will just be another place where politicians buy votes. Vote for me, and I will increase your “defined contribution” amount so you can either pay less for your gold plated insurance plan, or you can upgrade from bronze to silver and still pay nothing. Vote for me and I will make sure the minimum plan includes your desired medical care choices, such as more prescriptions paid for and your revirgination treatments!

Also, this is slightly OT, but those electric scooter commercials on TV piss me off, not because I want to keep old people from having electric scooters when they need them, but because the announcer says, “get yours today, and it is FREE!” Well, it is not free, maybe it is because of things like this, multiplied out 1000 times that the system is going bankrupt.

cep on October 16, 2012 at 10:58 AM

too funny, this is almost word by word the comment that my wife makes every time she sees that ad :)…personally I didn’t even think twice of that ad…I mean I tuned it out just as I tune most ads out, but it’s definitely bugging my wife…

Also, this is slightly OT, but those electric scooter commercials on TV piss me off, not because I want to keep old people from having electric scooters when they need them, but because the announcer says, “get yours today, and it is FREE!” Well, it is not free, maybe it is because of things like this, multiplied out 1000 times that the system is going bankrupt.

cep on October 16, 2012 at 10:58 AM

I’m with you on that!

What also p1sses me off about those companies is that by offering their “free” electric wheelchairs (which are actually paid for with our tax dollars), and skimming a handsome profit off the top, they’re making millions at the taxpayers’ expense.

Yes, it’s not as if any MSM outlet will report this. They’ll ignore it, just like they ignored all the other lies Biden spouted at the debate — like when he claimed that he had “always opposed” the wars in Afghanistan and Iraq, even though as a Senator he voted in favor of both.

Also, this is slightly OT, but those electric scooter commercials on TV piss me off, not because I want to keep old people from having electric scooters when they need them, but because the announcer says, “get yours today, and it is FREE!” Well, it is not free, maybe it is because of things like this, multiplied out 1000 times that the system is going bankrupt.

too funny, this is almost word by word the comment that my wife makes every time she sees that ad :)…personally I didn’t even think twice of that ad…I mean I tuned it out just as I tune most ads out, but it’s definitely bugging my wife…

jimver on October 16, 2012 at 11:10 AM

My mom, who is 78, see’s those commercials and they piss her off as well.

Do not trust the AMA. They are in it for the money that they make off of the proprietary use of CPT codes. The AMA is not the equivalent of doctors’ interests although some of their interests may overlap.

too funny, this is almost word by word the comment that my wife makes every time she sees that ad :)…personally I didn’t even think twice of that ad…I mean I tuned it out just as I tune most ads out, but it’s definitely bugging my wife…

jimver on October 16, 2012 at 11:10 AM

My mom, who is 78, see’s those commercials and they piss her off as well.

SWalker on October 16, 2012 at 11:18 AM

I believe you…at first, and as someone who grew up and lived in countries with socialized medicine most of my life (though never benefited from it) I thought that my wife’s comment was somewhat harsh, if not a bit callous, but on second analysis, it is the audacity of that ‘get yours today and it’s FREE’ that is most disturbing and symptomatic for the sorry state we are in, as a country, these days…both in terms of the ‘gimme’ mentality (and the selfishness associated with that) and in terms of the financial hardship this country is in as a result of said mentality…

The Council firmly believes that implementing a defined contribution system, with strong regulatory protections for patients, is a responsible and feasible approach to strengthening the Medicare program.

When you regulate something it costs more and you get less of it.

The government doesn’t pay the full cost of care for current users of the system which means that everyone else has to pony up more to support the subsidy. There is no zero middle-man cost, there is no zero cost of regulation, there is no zero cost for trying to protect everyone… yet the Left complains about spiraling cost of medical care because everyone has to bear this added cost.

The costs come in many forms such as mandatory maximum payments which don’t cover procedures, the cost of overhead for processing forms, the cost of having staff to manage the forms and overhead that comes with them, the time cost to doctors to being on the phone to justify their diagnoses and prescriptions… yet no one wants to address these costs that ‘regulations’ for ‘protections’ cost.

Now we are at the point where no one knows the true cost of medical care and, thusly, cannot put a true value on it. It is the medical system with its regulations, payments, kick-backs, write-offs all in search of ‘affordability’ that makes it so unaffordable and costly. Add in malpractice insurance, lawsuits, reduced payments by providers, time spent in disputes which is lost productivity and you get a real mess. All for the name of ‘doing good’ by trying to control costs by government fiat.

Astoni – your concern is relevant whenever the govt is open. This brings this spending more into the open and forces some market pressure to work on benficiaries. If you use too many services, your subsidy will buy less insurance next time round. POlitiicans who bunmp up the subsidy will have to face the voters.

At a certain point we are going to have to elect officials who will act like adults and not crack dealers. When they don’t we need to get rid of them. One step at a time.

Yes, medical care for seniors will change no matter what we do. But do we want the government in charge of that, or us?

A voucher, as I tell people, is no different than a Social Security check. You can spend it on whatever you want. So the purchasing power is in our hands, not the lobbyists…well, not as much in the hands of lobbyists.

Astoni – your concern is relevant whenever the govt is open. This brings this spending more into the open and forces some market pressure to work on benficiaries. If you use too many services, your subsidy will buy less insurance next time round. POlitiicans who bunmp up the subsidy will have to face the voters.

At a certain point we are going to have to elect officials who will act like adults and not crack dealers. When they don’t we need to get rid of them. One step at a time.

Zomcon JEM on October 16, 2012 at 11:40 AM

The biggest block of voters are the elderly. The baby boomers. When you use other people’s money to buy things you always over consume. When other peoples’ money buys less insurance, there is higher pressure to increase the pay outs. Politicians who refuse to increase those payouts will be voted out of office by the largest block of voters, those getting government subsidies.

The reason why the Ryan plan will never work. It makes the same stupid mistakes everyone else in government makes. It assumes that when you change the rules of the game people will keep on doing what they were already going to do.

I have seen people on government medical care. The three kids go to the doctor and take up his time, lie their asses off about being sick, to get out of school so they can go somewhere while everyone else is stuck in school. They also lie about their pain to get drugs, which then end up being sold to other people. When someone else is paying, on average, usage always increases.

The reason why the Ryan plan will never work. It makes the same stupid mistakes everyone else in government makes. It assumes that when you change the rules of the game people will keep on doing what they were already going to do.

Chain of Responsibility.
Self (that would be you the individual), Immediate Family (Parents, Wife, Children, Brothers and Sisters), Extended Family (Grandparents, Grandchildren, Aunts & Uncles, Cousins), Community friends and Charity (Neighbors, church, charitable organizations), Local Government, State Government, Federal Government.

If your lifestyle comes from anything related to government other than payment for services and supplies made to, then it is immoral, plain and simple. The rest of the chain of responsibility works on a volunteer basis and if you are not a good enough human being to be covered by all of those, then you sure as hell do not deserve what you ask for.